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Sternal closure

Yuki Tanaka, Takashi Miyamoto, Yuji Naito, Shuichi Yoshitake, Akihiro Sasahara, Kagami Miyaji
PURPOSE: To evaluate the safety and efficacy of our new delayed sternal closure (DSC) method, involving sternal semi-closure using a bioresorbable osteosynthesis device and complete skin closure. METHODS: Between 2013 and 2017, 36 patients underwent DCS at our hospital. The patients were divided into two groups based on the method used for DSC. The later conventional DSC group consisted of 18 patients undergoing late complete sternal closure following fixation of pulmonary and hemodynamic instability, and the new DSC group consisted of 18 patients undergoing early sternal semi-closure a few days after surgery...
March 16, 2018: Surgery Today
Pouya Nezafati, Ali Shomali, Mahdi Kahrom, Sahar Omidvar Tehrani, Minoo Dianatkhah, Mohammad Hassan Nezafati
BACKGROUND: The present study aimed to compare postoperative complications commonly revealed after sternotomy closure by new sternal ZipFix™ (Synthes GmbH, Oberdorf, Switzerland) implant and conventional steel wire. METHODS: Among the initial 360 subjects, 326 patients enrolled in this randomised control trial who were candidates for cardiac surgery from April 2014 to March 2015. After the surgery, the sternal closure was randomly done with poly-ether-ether-ketone (PEEK) based sternal ZipFix (ZF) on the sternal body (n=168) or with conventional wires (CWs) (n=158)...
February 8, 2018: Heart, Lung & Circulation
Tetyana Leinberger, Claudia Heilmann, Stefan Sorg, Matthias Mueller, Sami Kueri, Claudia Schmoor, Matthias Siepe, Friedhelm Beyersdorf
BACKGROUND:  Median sternotomy in patients with risk factors for wound healing is associated with high rates of postoperative wound infections and sternum instability. METHODS:  A total of 338 patients with elective first median sternotomy and at least four predefined risk factors were randomized between Sternal Talon (Gebrüder Martin GmbH & Co. KG-KLS Martin Group, Tuttlingen, Germany) and wire cerclage. The primary end point was mediastinitis and/or sternal instability within 30 ± 5 days, and the secondary end points were mediastinitis and/or sternal instability within 60 ± 5 days; incidence of pneumonia during hospitalization within the first 30 (±5) days and chest pain intensity...
February 2, 2018: Thoracic and Cardiovascular Surgeon
M H Zou, L Ma, Y S Xia, S C Yang, W D Chen, F Cao, X X Chen
Objective: To review the early and mid-term results of end-to-side anastomosis technique for interrupted aortic arch in neonates and infants. Methods: Clinic data of 46 patients were diagnosed as interrupted aortic arch in Department of Cardiac Surgery, Guangzhou Women and Children's Medical Center between January 2010 and December 2016 were analyzed retrospectively. Twenty-six cases were neonates. The median age underwent surgery was 23 days (range: 2 days to 8 years). Anatomical subtypes included 36 cases of type A and 10 cases of type B...
March 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Andy C Kiser, Thomas G Caranasos, Mark D Peterson, David M Holzhey, Philipp Kiefer, L Wiley Nifong, Michael A Borger
OBJECTIVE: Recently, the PARTNER 2A trial reported results of transcatheter aortic valve replacement versus surgical aortic valve replacement in 2032 intermediate-risk patients at 2 years. Two hundred thirty-six patients (24%) required an access route other than transfemoral. Compared with transfemoral and surgical aortic valve replacement, nontransfemoral transcatheter aortic valve replacement was associated with a numerically higher rate of death and disabling stroke at 30 days. This underscores the need for a better alternative surgical approach for patients with marginal femoral access...
February 17, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Karl Waked, Philippe Ballaux, Dominique Goossens, Koen Cathenis
The objective is to describe the 'Two Bridges Technique' (TBT), which has proven to be successful and has been the standard technique at our centre for vacuum-assisted closure (VAC) of post-sternotomy mediastinitis. An extensive literature search was performed in four databases to identify all published articles concerning VAC for post-sternotomy mediastinitis. Several VAC methods have been used; however, no article has described our specific technique. TBT consists of a two-bridges construction using two types of foam with different pore sizes, which ensures an equally divided negative pressure over the wound bed and stabilisation of the chest...
February 12, 2018: International Wound Journal
David T M Burtman, Annick Stolze, Selma E Kaffka Genaamd Dengler, Alexander B A Vonk, Christa Boer
OBJECTIVE: Evaluate minimally invasive assessment of oxygen delivery (DO2) and oxygen consumption (VO2) and determine its level of agreement with the gold standard approach of those measurements in patients undergoing cardiac surgery. DESIGN: Observational study. SETTING: Single center, VU University Medical Center (Amsterdam, The Netherlands). PARTICIPANTS: The study comprised 29 adult patients. INTERVENTION: Parallel measurements of invasive and minimally invasive parameters required for the calculation of DO2 and VO2...
June 27, 2017: Journal of Cardiothoracic and Vascular Anesthesia
María Benito, Alexandra Muñoz, Isabel Beltrán, Elena Labajo, Bernardo Perea, José Antonio Sánchez
It is a fact that in recent years requests have greatly increased to obtain estimates of the legal age of undocumented individuals alleged to be minors who have been forced to enter different European Community countries for socioeconomic reasons or due to war. Spain is one of the countries most affected by this illegal immigration because of its proximity to North Africa. Therefore, it has become necessary to develop new standards which help provide a response to the demands of the justice administration. In recent years, the Superior Justice Court has rejected several pieces of expert evidence on the grounds that the age intervals therein were not sufficiently reliable and that the radiographic techniques used to determine age were invasive, potentially causing harm to the alleged minor...
January 29, 2018: Forensic Science International
Ding Wen Wu, Yu Xia, Joan Uelinger, Stephen Forest, James Szymanski, Kala Mohandas, Ronald Walsh, Sadiqa Karim, Etan Marks, Evan Himchak, Ritu Gupta, Daniel Goldstein
BACKGROUND: Left ventricular assist device (LVAD) recipients undergoing heart transplantation have increased bleeding risk. We compared conventional warfarin reversal with fresh frozen plasma vs 4-factor prothrombin complex concentrate (PCC) and the effect on transfusion requirements, blood bank costs, and clinical outcomes. METHODS: A retrospective review identified 60 consecutive LVAD recipients undergoing heart transplantation divided into two groups: 30 (no PCC) received fresh frozen plasma and 30 (PCC) received PCC...
February 1, 2018: Annals of Thoracic Surgery
Xicheng Deng, Peng Huang, Liwen Yi, Xiaohui Yang, Cheng He
RATIONALE: Pectus excavatum (PE) in the setting of congenital heart disease is not uncommon. The surgical strategy has evolved over the last 20 years from a staged approach to simultaneous repair of both defects. PATIENT CONCERNS: A 3-year-old boy was admitted for elective repair of PE and atrial septal defect (ASD). DIAGNOSES: Clinically, there were obvious features of PE and a grade 2 systolic murmur heard loudest at the 2nd intercostal space abutting the left sternal border...
December 2017: Medicine (Baltimore)
Keith B Allen, Vinod H Thourani, Yoshifumi Naka, Kendra J Grubb, John Grehan, Nirav Patel, T Sloane Guy, Kevin Landolfo, Marc Gerdisch, Mark Bonnell, David J Cohen
BACKGROUND: In a multicenter randomized trial, sternal closure following cardiac surgery using rigid plate fixation (RPF) compared with wire cerclage (WC) resulted in improved sternal healing, reduced sternal complications and was cost neutral at 6 months. Additional secondary endpoints are presented from this trial. METHODS: Twelve US centers randomized 236 patients to RPF (n=116) or WC (n=120). Patient reported outcomes measures (PROMs) including pain, function, and quality-of-life (QOL) scores were assessed through 6-months and correlated to computed tomographic derived sternal healing scores using logistic regression...
January 11, 2018: Annals of Thoracic Surgery
Jamie L Eckardt, Matthew R Wanek, Chiedozie I Udeh, Elizabeth A Neuner, Thomas G Fraser, Tamer Attia, Eric E Roselli
BACKGROUND: Clinical practice guidelines provide recommendations for surgical prophylaxis in patients undergoing cardiothoracic procedures. However, there are currently no recommendations guiding the management of antibiotic prophylaxis in patients requiring delayed sternal closure following cardiothoracic surgery. METHODS: This is a single-center, retrospective analysis. Data was extracted from the Society of Thoracic Surgery (STS) Database and electronic medical record for the time period of July 2011 - January 2016...
January 11, 2018: Annals of Thoracic Surgery
Takuma Fukunishi, Norihiko Oka, Takeshi Yoshii, Kensuke Kobayashi, Nobuyuki Inoue, Tetsuya Horai, Tadashi Kitamura, Hirotsugu Okamoto, Kagami Miyaji
Early extubation in the operating room after congenital open-heart surgery is feasible, but extubation in the intensive care unit after the operation remains common practice at many institutions. The purpose of this study was to evaluate retrospectively the adequacy of our early-extubation strategy and exclusion criteria through analysis based on the Risk Adjustment in Congenital Heart Surgery method (RACHS-1).This retrospective analysis included 359 cases requiring cardiopulmonary bypass (male, 195; female, 164; weight > 3...
January 15, 2018: International Heart Journal
Lukas Capek, Petr Henys, Martin Kalab, Pavel Solfronk
OBJECTIVES: The number of turns at the end of a wire closure is not described or discussed in any cardiosurgical guidelines. The hands-on experience of the surgeon plays a significant role. The aim of this work was to clarify the relationship between the number of turns of the suture and the resulting strength of the sternal fixation. METHODS: The study was performed in 2 independent steps. The first step was a finite element simulation, where the stress and strain distribution of the sternal fixation was observed...
January 8, 2018: Interactive Cardiovascular and Thoracic Surgery
Takeshi Hatachi, Kazuya Tachibana, Yu Inata, Yuji Tominaga, Aiko Hirano, Miyako Kyogoku, Kazue Moon, Yoshiyuki Shimizu, Kanako Isaka, Muneyuki Takeuchi
OBJECTIVES: Healthcare-associated infections after pediatric cardiac surgery are significant causes of morbidity and mortality. We aimed to identify the risk factors for the occurrence of healthcare-associated infections after pediatric cardiac surgery. DESIGN: Retrospective, single-center observational study. SETTING: PICU at a tertiary children's hospital. PATIENTS: Consecutive pediatric patients less than or equal to 18 years old admitted to the PICU after cardiac surgery, between January 2013 and December 2015...
January 9, 2018: Pediatric Critical Care Medicine
Camille Bismuth, Claire Deroy
Case summary: Cranial ventral midline hernias, most often congenital, can be associated with other congenital abnormalities, such as sternal, diaphragmatic or cardiac malformations. A 4-year-old multiparous queen with a substernal hernia was admitted for evaluation of a mammary mass. During CT examination, a bifid sternum, the abdominal hernia containing the intestines, spleen, omentum, three fetuses, a mammary mass and an incidental peritoneopericardial diaphragmatic hernia were identified...
July 2017: JFMS Open Reports
Thomas P Sullivan, James E Moore, Andrew A Klein, David P Jenkins, Lynne K Williams, Andrew Roscoe, Wendy Tsang
OBJECTIVE: Patients undergoing pulmonary endarterectomy (PEA) have impaired right ventricular function. The authors sought to assess the clinical utility of commonly used perioperative echocardiographic and right heart catheter measurements in patients undergoing PEA. DESIGN: A single-center prospective observational study. SETTING: The study was conducted in a quaternary care cardiac surgical center in the United Kingdom. PARTICIPANTS: Patients undergoing PEA between April 2015 and January 2016...
September 21, 2017: Journal of Cardiothoracic and Vascular Anesthesia
Noritaka Ota, Sivakumar Sivalingam, Kiew Kong Pau, Chee Chin Hew, Jeswant Dillon, Haifa Abdul Latiff, Hasri Samion, Mohd Azhari Yakub
OBJECTIVE: We introduced primary arterial switch operation for the patient with transposition of great arteries and intact ventricular septum (TGA-IVS) who had more than 3.5 mm of posterior left ventricle (LV) wall thickness. METHODS: Between January 2013 and June 2015, a total of 116 patients underwent arterial switch operation. Of the 116 patients, 26 with TGA-IVS underwent primary arterial switch operation at more than 30 days of age. RESULTS: The age and body weight (mean ± SD) at the operation were 120...
January 2018: World Journal for Pediatric & Congenital Heart Surgery
Matthew R Danter, Amy Saari, Min Gao, Anson Cheung, Samuel V Lichtenstein, James G Abel
OBJECTIVE: Morbidity due to sternotomy continues to be a significant clinical problem. Poor approximation of the sternum may lead to complications such as sternal dehiscence, infection, and pain. A device to assist in tensioning and twisting standard steel wires during sternal closure has been developed (TORQ sternal closure device). Manually tightened interrupted wire closures were compared with those tightened and secured with the aid of the device. Performance of the device was assessed clinically...
January 4, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Ludovic Melly, Anne-Sophie Dincq, Claude Hanet, Benoît Rondelet
BACKGROUND: Osteogenesis imperfecta is a genetic disorder of connective tissue causing mostly left-sided heart valves and aortic root pathologies, but a coronary artery involvement reflecting an increased sensitivity to cardiovascular risk factors is also suspected in this patient population. CASE PRESENTATION: We report a 38-year-old patient with an osteogenesis imperfecta and a typical presentation of an acute myocardial infarction. The coronary angiogram showed a coronary 3-vessel disease...
December 19, 2017: Journal of Cardiothoracic Surgery
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